MOC Scoring Guidelines Presentation

Report
Model of Care
Scoring Guidelines
SNP Educational Session - January 13, 2014
Brett Kay, AVP, SNP Assessment, NCQA
SNP Educational Session – January 13, 2014
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Objectives of SNP MOC
Scoring Guidelines
• Raise the bar and strengthen the guidelines
• Modeled after S&P measures format
– Familiar to the SNPs
– SNPs have publicly requested such a change
– Supports consistent scoring of MOCs
SNP Educational Session – January 13, 2014
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MOC Scoring Guidelines
• Used revised Appendix 1 of the MA
application Model of Care Matrix Upload
Document—kept requirements intact, but
revised formatting
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How will NCQA Score the MOC?
• Scoring will be similar to previous years
• MOC elements worth 0-4 points, based on
# of factors met
• Total of 60 points (15 elements)
• Converted to percentage scores
– E.g., 50 points = 83.33% (2-year approval)
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Scoring
Previous MOC Scoring Guidelines
Element
New MOC Scoring Guidelines
Maximum Score
Element
Maximum Score
MOC 1: SNP-specific Population
4
MOC 1: SNP Population
8
MOC 2: Measurable Goals
12
MOC 2: Care Coordination
20
MOC 3: Staff Structure/roles
12
MOC 3: Provider Network
12
MOC 4: ICT
12
MOC 4: Quality Measurement
20
MOC 5: Provider Network
20
Total
60
MOC 6: MOC Training
16
MOC 7: HRA
16
MOC 8: ICP
20
MOC 9: Communication Network
16
MOC 10: Vulnerable Populations
8
MOC 11: Outcome Measurement
24
Total
160
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Public Comment Process
• NCQA held a two week public comment
period to solicit comments on the draft
scoring guidelines
• Received input from stakeholders
– 222 comments
– Health plans, trade associations, provider
groups, others
• Used feedback to revise guidelines and
clarify expectations
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Public Comment-Major Themes
• MOC Audit Issues—requests for
clarification/interpretation of
requirements; reaction to CMS’ review of
MOC during the audit cycle
• Requests for better harmonization &
coordination of MOC and S&P measures
assessments
• Redundancy with existing MA
requirements
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Public Comment-Major Themes
• Network Model vs. Staff Model—some
requirements not feasible/heavy burden
for network model SNPs
• Plan level vs. member-level data and
information
• High risk/stratification for ICP/ICT-focus on
high need members
• Requests for examples, expectations of
intent
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MOC 1: Description of SNP Population
• Element A: Overall SNP Population– Intent: Identify and describe the target
population, including health and social
factors, and unique characteristics of each
SNP type
– Response to public comments:
• Factor 1: Clarify that emphasis is on process, not
care coordination
• Factors 2 & 3: Separated social and
medical/health factors
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MOC 1: Description of SNP Population
• Element B: Most Vulnerable Beneficiaries
– Intent: Describe the most vulnerable
beneficiaries and how their medical and
social factors affect health outcomes and
what services and resources the SNP provides
to address these
– Response to public comments:
• Clarify that focus is on population-level, not
individual members
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MOC 2: Care Coordination
• Element A: Staff Structure
– Intent: Describe administrative and clinical
staff roles and responsibilities
– Response to public comments:
• Factor 2: Oversight functions related to license and
competency verification relates to specific
population being served
• Factor 4: Contingency plans are developed for
plan-level operations
• Factors 5&6: Clarify that contracted staff do not
include contracted network providers
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MOC 2: Care Coordination
• Element B: Health Risk Assessment Tool
– Intent: Describe process for using HRAT to
inform development of the ICP; communicate
HRAT info to ICT; identify and stratify needs of
beneficiaries
– Response to public comments:
• Factor 3: Establish that all SNP beneficiaries must
receive an HRA
• Factor 3: SNPs should describe how they address
beneficiaries that cannot or will not undergo an
HRA
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MOC 2: Care Coordination
• Element C: Individualized Care Plan (ICP)
– Intent: Describe essential elements of the ICP,
how the SNP develops and updates the ICP
– Response to public comments:
• Clarify that CMS expects an ICP for all SNP
beneficiaries but allows flexibility for SNP to
determine level of detail for ICPs—may stratify by
risk and place priority on high risk/high need
beneficiaries
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MOC 2: Care Coordination
• Element D: Interdisciplinary Care Team (ICT)
– Intent: Describe the ICT, including key members, roles and
responsibilities and how they contribute to improving beneficiary
health status.
– Response to public comments:
• Clarify that the ICT may meet “virtually” using various forms of
communication and technology (face-to-face is not required)
• Element E: Care Transition Protocols
– Intent: Describe the SNP’s processes to coordinate care transitions
and facilitate timely communications across settings and
providers
– Response to public comments:
• Factor 2: Delete requirement about providing staff credentials
• Factor 5: Revise to match AHRQ language on self management
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MOC 3: Provider Network
• Element A: Specialized Expertise
– Intent: Demonstrate how the network is designed to address the
needs of the SNP’s target population
– Response to public comments:
• Focus is on plan-level information for the provider network
• Factor 3: Remove language on credentialing
• Element B: Use of clinical practice guidelines (CPGs)
and Care Transitions Protocols
– Intent: Describe how the SNP ensures that beneficiaries receive
appropriate, evidence-based care and services
– Response to public comments:
• Population level decision making, not individual clinician level
• Identify challenges to using CPGs and protocols
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MOC 3: Provider Network
• Element C: Provider Network Training
– Intent: Describe how the SNP provides training
for its provider network
– Response to public comments:
• SNPs should show how they make training
available to all network providers
• Make providers aware of trainings
• Offer various training modalities to suit the needs
of network providers
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MOC 4: MOC Quality Measurement &
Performance Improvement
• Element A: Quality Performance
Improvement Plan
– Intent: Describe how the SNP conducts quality
improvement related to its overall MOC
– Response to public comments:
• Plan-level information focusing on goals that
measure overall plan performance related to all
aspects of the MOC
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MOC 4: MOC Quality Measurement &
Performance Improvement
• Element B: Measureable Goals
– Intent: Identify and define the measureable
goals and health outcomes for the target
population, and how the SNP determines if
goals are being met
– Response to public comments:
• Plan-level measures and goals for the target
population
• Focus is on health and clinical goals (e.g.,
controlling diabetes, mental health screening)
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MOC 4: MOC Quality Measurement &
Performance Improvement
• Element C: Measuring Patient Experience
– Intent: Describe how the SNP measures
beneficiary satisfaction and responds to
results
– Response to public comments:
• Plans may use wide variety of patient
experience/satisfaction surveys—CAHPS and HOS
are acceptable, as are other alternatives
• Provide details of surveys and methodology for
data collection
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MOC 4: MOC Quality Measurement &
Performance Improvement
• Element D: Ongoing Performance
Improvement Evaluation
– Intent: Describe how the SNP uses the results
from its performance indicators and
measures to support its ongoing quality
improvement plan
– Response to public comments:
• Include lessons learned and challenges in
obtaining timely data
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MOC 4: MOC Quality Measurement &
Performance Improvement
• Element E: Dissemination of SNP Quality
Performance
– Intent: Describe how the SNP communicates
its quality improvement plan and
performance to stakeholders
– Response to public comments:
• Detail who receives the information, how often
they receive it, and what communication methods
are used
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QUESTIONS
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